Provider Demographics
NPI:1255659561
Name:MEDICAL ONCOLOGY ASSOCIATES PS
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-664-4026
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0996
Mailing Address - Country:US
Mailing Address - Phone:208-664-4026
Mailing Address - Fax:208-664-4840
Practice Address - Street 1:6001 N MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1129
Practice Address - Country:US
Practice Address - Phone:509-462-2273
Practice Address - Fax:509-462-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0004581842085R0202X
WAMD000447962085R0202X
WAMD000461892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty